Twelve-month prospective, multinational, observational study of factors associated with recovery from mania in bipolar disorder in patients treated with atypical antipsychotics

Abstract

Objectives. Atypical antipsychotic agents constitute one therapeutic approach for bipolar disorder. Since disease course and outcome are variable, further studies are needed to complement limited data supportive of clinical decisions at treatment initiation. Methods. This 12-month, prospective, observational study investigated factors associated with symptomatic remission (total YMRS score ≤12) and full clinical recovery (sustained reduction in CGI-BP-S overall score) in bipolar disorder during treatment with atypical antipsychotics (predominantly olanzapine, risperidone and quetiapine; alone or in combination with a psychotropic such as lithium or valproate) in actual clinical practice. Results. Amongst 872 enrolled and eligible patients, rates of symptomatic remission and full clinical recovery at 12 months were 93.0 and 78.5%, respectively. Of the baseline factors significantly (P≤0.05) associated with symptomatic remission, the following categories were positively associated with a higher chance of symptomatic remission: Caucasian ethnicity; higher CGI-BP-S scores; family-dependent living; a previous manic episode; 1, 2 or ≥5 social activities; no work impairment; and being neither satisfied nor dissatisfied with life. Outpatient treatment and historically longer periods of mania were significantly positively associated with full clinical recovery. Conclusions. While clinical status may also be associated with longer-term remission and recovery, factors relating to social functioning and quality of life are easily assessed and potentially modifiable. Such knowledge may aid physicians' clinical decisions regarding patients with bipolar mania treated with atypical antipsychotics.

Key words::

• Antipsychotic
• bipolar disorder
• olanzapine
• remission
• recovery

Acknowledgements

Study sponsorship was provided by Eli Lilly and Company. The author would like to thank Anton Kamyshev (InnoPharm) and Sireesha Pamulapati (Eli Lilly and Company) for performing data analysis and Jo Wood (Meditech Media Asia Pacific Pty Ltd) for providing writing support. The contributions of all of the investigators, assistants and patients that participated in this study are also gratefully acknowledged.

Statement of interest

Tamás Treuer, Yulia D'yachkova and Gavan Harrison are employees of Eli Lilly. Dimitris Dikeos has participated on speaker/advisory boards and/or has received honoraria from AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly, Genesis Pharma, GlaxoSmithKline, Janssen-Cilag, Lundbeck, Sanofi-Aventis, Uni-Pharma and Wyeth. Marjeta Blinc Pesek has received honoraria from Eli Lilly, Janssen-Cilag, PharmaSwiss and Sanofi-Aventis. Zsolt Fábián has received speaker honoraria from AstraZeneca, Bristol-Myers Squibb, Egis Pharmaceuticals, Eli Lilly, Pfizer, Gedeon Richter Pharmaceuticals and Valeant Pharma. Tarek Okasha has received speaker honoraria from Eli Lilly, Janssen-Cilag, Lundbeck, Pfizer and Wyeth. Mohamed Gamal Badr, Fude Yang, Guillermo Tapia-Paniagua and Cristina Hudiţă have no conflicts of interest to disclose.